Original ArticlesPersistence of Cushing’S DiseasePersistence of Cushing’s Disease Symptoms and Comorbidities After Surgical Cure: a Long-Term, Integral Evaluation
Section snippets
INTRODUCTION
The complications and comorbidities of Cushing’s disease (CD) were thought for the most part to be reversible upon normalization of hypercortisolism by successful removal of the adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma (1). However, recent longterm follow-up of surgically cured patients has suggested that some of the consequences of the previous glucocorticoid excess do not remit completely upon normalization of the corticotrophic axis. Persistent clinical abnormalities
METHODS
The study included patients who had undergone surgery for pituitary ACTH-producing adenomas at the Hospital de Especialidades, Centro Médico Nacional S. XXI, IMSS between July 1997 and March 2010. Our inclusion criteria were as follows: (1) documentation of CD either by bilateral inferior petrosal sinus sampling or positive ACTH immunostaining of the excised adenoma tissue; (2) complete preoperative clinical and biochemical information; (3) documentation of postoperative biochemical cure one to
Statistical Analysis
Quantitative data are presented as means ± standard deviation (SD) when normally distributed and as medians with interquartile ranges (IQRs) when not. Data distributions were ascertained with Shapiro-Wilk tests. The proportions of each clinical variable were reported before and after surgical treatment. McNemar’s test for dependent samples was performed to assess differences among proportions at diagnosis and at both postsurgical evaluations. To ascertain if symptom and comorbidity persistence
RESULTS
The study included 29 patients (27 women; mean age at diagnosis of 35.6 ± 8.4 years; range, 16 to 57 years) who met the biochemical CD cure criteria after pituitary surgery. Table 1 depicts the basal characteristics of the patients prior to pituitary surgery. Twenty-four patients (82.7%) developed acute hypocortisolism (mean serum cortisol, 1 ± 0.7 μg/dL) within 15 days of surgery and were maintained on glucocorticoid replacement therapy (prednisone 5 mg daily, oral hydrocortisone is not
DISCUSSION
This is the first investigation that systematically assessed the persistence of CD comorbidites at 2 different time points after resolution of hypercortisolism by TSS. Previous studies have chosen to evaluate specific elements of metabolic syndrome, including body fat distribution and obesity (6), glucose metabolism abnormalities and diabetes (2., 3., 4., 5.), dyslipidemia (2., 3., 4., 5., 6.), and hypertension (3,8). The majority of these have compared cured CD patients to either biochemically
CONCLUSION
We conclude that in a variable proportion of patients, some of the metabolic and emotional comorbidities of CD persist after long-term surgical remission, irrespective of the initial degree of hypercortisolism. We postulate that such persistence is in some way related to the recently reported increased mortality in these patients, even after their condition is successfully cured (17., 18.).
DISCLOSURE
The authors have no multiplicity of interest to disclose.
REFERENCES (18)
- et al.
The metabolic syndrome and cardiovascular risk in Cushing's syndrome
Endocrinol Metab Clin North Am
(2005) - et al.
Effect of surgical treatment on hypertension in Cushing's syndrome
Am H Hypert
(1996) - et al.
Diagnosis and complications of Cushing's syndrome: a consensus statement.
J Clin Endocrinol Metab
(2003) - et al.
Metabolic and cardiovascular outcomes in patients with Cushing's syndrome of different aetiologies during active disease and 1 year after remission
Clin Endocrinol (Oxf)
(2011) - et al.
Diagnosis of cure in Cushing's syndrome: lessons from long-term follow-up
Front Horm Res
(2010) - et al.
Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing's disease during active disease and 1 year after disease remission
J Clin Endocrinol Metab
(2003) - et al.
Persistent body fat mass and inflammatory marker increases after long-term cure of Cushing's syndrome
J Clin Endocrinol Metab
(2009) - et al.
Normal bone mineral density following cure of Cushing's syndrome
Clin Endocrinol (Oxf)
(1992) - et al.
Persistence of increased cardiovascular risk in patients with Cushing's disease after five years of successful cure
J Clin Endocrinol Metab
(1999)
Cited by (13)
Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess
2022, Reviews in Endocrine and Metabolic DisordersIdentification of glucocorticoid-related molecular signature by whole blood methylome analysis
2022, European Journal of EndocrinologyThe Interaction of Insulin and Pituitary Hormone Syndromes
2021, Frontiers in EndocrinologyACTH Producing Adenomas: Cushing’s Disease
2019, Advanced Practice in Endocrinology Nursing